Objective To assess the effectiveness and safety of high-dose chemotherapy assisted with autologous peripheral blood stem cell treatment (APBSCT+HDC) for small cell lung cancer (SCLC). Methods The databases such as MEDLINE (1970 to January 2011), EMBASE (1980 to January 2011), Science Direct (1980 to January 2011), The Cochrane Library (Issue 3, 2010), CNKI (from the date of establishment to December 2010), CBM (from the date of establishment to December 2010) and Wanfang database (from the date of establishment to December 2010) were searched for collecting randomized controlled trials (RCTs) on APBSCT+HDC for SCLC. According to the inclusive and exclusive criteria, the trials were screened, the data were extracted, the methodological quality was assessed, and then Meta-analysis was conducted by using RevMan 5.0 software. Results A total of 6 RCTs involving 737 patients with SCLC were included. The results of Meta-analyses were as follows: the APBSCT+HDC for SCLC was significantly superior to the conventional chemotherapy in the total effective rate (RR=1.14, 95%CI 1.07 to 1.21, Plt;0.000 1) and the overall survival rate (RR=3.74, 95%CI 2.13 to 6.58, Plt;0.000 01), and it was superior in reducing the incidence of III/IV grade red blood cell reduction (RR=1.97, 95%CI 1.15 to 3.38, P=0.01) and thrombopenia (RR=1.93, 95%CI 1.06 to 3.54, P=0.03) with significant differences; but there was no significant difference between the two groups in reducing the incidence of III/IV leukopenia. Conclusions Compared with the conventional chemotherapy, APBSCT+HDC treatment for SCLC can improve the overall effective rate and overall survival rate, but it can also increase the risks of severe hematologic toxic reaction. Because of the small scale and low quality of the included studies, this conclusion still needs to be confirmed by high-quality, large-scale and multi-centered RCTs.
Objective To assess the effectiveness and safety of autologous stem cell transplantation after high-dose chemotherapy in first-line treatment of follicular lymphoma. Method Randomized controlled trials (RCTs) of autologous stem cell transplantation after high-dose chemotherapy in first-line treatment of follicular lymphoma were collected from MEDLINE (1990-2009), EMBASE (1990-2009), OVID (1990-2009), and the Cochrane Library (Issue 2, 2009), and the proceedings of ASH were searched manually. The methodological quality of included studies was evaluated, and data analysis was performed with software STATA 10.0 and RevMan 4.3. Result A total of 4 RCTs involving 941 patients were included. The results of meta-analysis showed that overall survival rate (HR=0.82, 95%CI 0.49 to 1.15), event-free survival rate (HR=0.35, 95%CI 0.24 to 0.47), total remission rate (RR=0.35, 95%CI 0.96 to 1.30), and secondary malignant tumor incidence rate (RR=1.68, 95%CI 0.47 to 6.07). Conclusion According to the present evidences, autologous stem cell transplantation after high-dose chemotherapy can not improve overall survival rate and total remission rate, but can improve event-free survival rate, and do not increase secondary malignant tumor incidence rate. However, more high-quality, multiple-center, large-sample randomized controlled trials are required.
Objective To assess the efficacy of high-dose chemotherapy versus moderate-dose chemotherapy in the treatment of osteosarcoma. Methods We searched MEDLINE, EMbase, OVID database, CBMdisc, Cochrane CENTRAL Register of Controlled Trials in The Cochrane Library, and handsearched Journal of Chinese Oncology, Journal of Chinese Clinical Oncology and Tumor. The search time was updated to Feburary 2006.The quality of the included studies was evaluated by two reviewers and meta-analyses were performed on the results of homogenous studies. Results Four studies involving 937 participants with primary, high-grade and non-metastatic extremity osteosarcoma were included. All the included studies were judged to be inadequate at reporting randomization and blinding, only one reported allocation concealment. All included studies reported the number of withdrawals and the reasons for these. The meta-analyses showed that there were no significant differences in 5-year event free survival (EFS) (RR 1.10, 95% CI 0.96 to1.25), 5-year overall survival (OS) (RR 1.08, 95% CI 0.97 to1.20), local recurrence rate (RR 0.92, 95% CI 0.54 to 1.57), proportion of good histological response (RR 0.93, 95% CI 0.81 to 1.07), proportion of limb salvage [RR 0.97, 95% CI 0.92 to 1.02) between the high-dose group and the moderate-dose group. The 5-year EFS of the good histological response group was significantly higher than in the poor histological response group [OR 2.45, 95% CI 1.76 to 3.39,Plt;0.00001 ). Conclusions No advantage is shown for high-dose chemotherapy over moderate-dose chemotherapy in 5-year EFS, 5-year OS, local recurrence rate, proportion of good histological response and proportion of limb salvage. Histological response to preoperative chemotherapy is an independent prognosis factor for osteosarcoma. Due to the potential risk of selection bias, performance bias and publication bias, the evidence is not b enough to judge whether high-dose chemotherapy is better than moderate-dose chemotherapy in the treatment of osteosarcoma. Our conclusion suggests that large-scale randomized trials should be performed.
【摘要】 目的 研究大剂量辣椒素对兔肺P物质和降钙素基因相关肽(CGRP)的影响。方法 将16只成年健康雄性新西兰大白兔随机分为两组:载体组(A)、大剂量辣椒素组(B)。两组动物取样前7 d和前6 d分别于颈部皮下注射等量的载体或者辣椒素(20 mg/mL)。大剂量戊巴比妥钠静脉麻醉处死动物后立即切取左肺下叶,称重,匀浆,离心后取上清液置于-80℃冰箱保存待测P物质和CGRP。结果 A组肺组织中P物质的浓度高于B组(Plt;0.05),而CGRP的浓度两组差异无统计学意义(P＞0.05)。结论 大剂量辣椒素(100 mg/kg)不能完全耗竭兔肺初级感觉神经纤维的神经肽类物质。
目的:多发性骨髓瘤(Multiple Myeloma,MM)患者约有80%伴有贫血,临床上多数患者以输血方式纠正贫血。重组人促红细胞生成素(recombinant human erythropoietin, rHuEPO)用于治疗MM患者的贫血尽管有效,但以何等剂量、应用多长时间疗效较佳尚无定论。目的: 观察持续使用大剂量rHuEPO对MM患者贫血的纠正作用及效果。方法:87例诊断明确的多发性骨髓瘤伴有贫血的患者,开始连续每天使用重组人促红细胞生成素4万单位,皮下注射,共5d;以后每周使用一次,每次4万单位皮下注射,间断补充铁剂。对照组90例选自同期住院的诊断明确的多发性骨髓瘤患者,当其贫血症状明显时或血红蛋白水平低于60 g/L时,给予输血纠正其贫血,使多数患者血红蛋白水平维持在80 g/L～100 g/L以上。两组患者化疗方案不做特殊规定,整过研究观察期6月。结果: rHuEPO组在使用rHuEPO后2周其血红蛋白开始上升,中位反应时间16d;1月半至2月血红蛋白可升至正常水平,达正常血红蛋白水平的中位时间51d。进入研究后3月和6月时,rHuEPO组生活幸福感指数(INLH)明显优于输血组,分别为6927±318(Plt;005)和7216±283(Plt;001)与5835±289和5776±324。6月后,rHuEPO组平均每例直接费用成本1075440元,明显低于输血组需要达到同样效果所需的每例2070420元。结论:大剂量rHuEPO治疗MM相关性贫血优于输血,其起效快、疗效好,患者生活幸福感改善明显,费用成本低,安全性较好。
ObjectivesTo analyze patients’ values and preferences on individualized medication of high-dose methotrexate so as to support the development of the practice guideline for clinical medication of high-dose methotrexate.MethodsA multicenter cross-sectional study involving patients with osteosarcoma or hematological malignancy in 7 hospitals was conducted by questionnaires to evaluate the perception and willingness on detection of gene polymorphisms (MTHFR C677T, MTHFR A1298C, ABCB1 C3435T and RFC1 G80A) related to methotrexate (MTX) and therapeutic drug monitoring (TDM) of MTX. SPSS24.0 software was used to analyze the data.ResultsA total of 124 patients were involved, including 40 (32.26%) with osteosarcoma and 84 (67.74%) with hematological malignancy. 106 (85.48%) and 117 (94.35%) patients agreed on detection of gene polymorphisms and TDM, respectively. There was a significant difference on preference towards TDM between patients with risk factors for MTX and patients in which risk factors for MTX were not discovered (76.19% vs. 95.08%, P=0.003). The ranking of factors that contributed to the two decision-making was consistent (P<0.01), and specific orders of factors were identical. The clinical efficacy was the primary factor (mean rank 3.45 for detection of genetic polymorphisms and 3.52 for TDM), followed by safety (mean rank 3.01 and 3.16, respectively) and comfort (mean rank 1.73 and 1.79, respectively). Cost (mean rank 1.39 and 1.31, respectively) was the least important factor.ConclusionsThe preferences of patients toward detection of gene polymorphisms and TDM were generally similar, with well acceptance. No significant differences were found on the preferences toward detection of gene polymorphisms. However, patients with or without risk factors for MTX may differ significantly when making decisions on TDM, which may impact on clinical decision-making of clinicians and clinical pharmacists. The perception and willingness of patients should be considered adequately during the development of clinical practice guidelines and clinical practice.
Helicobacter pylori (HP) infection is common worldwide, and the first-line eradication regimen recommended by domestic and foreign guidelines faces many challenges in practical application. In order to further improve the HP eradication rate and patient compliance, problems such as increased antibiotic resistance, a wide variety of drugs, and obvious drug side effects need to be solved urgently. In recent years, high-dose dual therapy of amoxicillin combined with proton pump inhibitor have achieved good eradication effect in the treatment of HP infection. This article reviews the action mechanism, safety and therapeutic effect of high-dose dual therapy, aiming to provide a reference for clinical diagnosis and treatment.
Objective To evaluate the efficacy and safety of high-dose dual therapy (HDDT) in the treatment of Helicobacter pylori (HP) infection. Methods The clinical data of patients with HP infection who were treated in Suining Central Hospital between June 2020 and August 2021 were retrospectively collected. They were divided into HDDT group and bismuth-containing quadruple therapy (BQT) group according to the treatment regimen. The efficacy and adverse reactions of the two treatment regimens were observed. Results A total of 520 patients were included. Among them, there were 284 cases in the HDDT group and 236 cases in the BQT group. By propensity score matching, 223 pairs of patients were successfully matched. The eradication rates of HDDT and BQT were 74.4% and 77.1%, respectively (χ2=0.440, P=0.507), and the incidence of adverse reactions were 9.9% and 16.6%, respectively (χ2=4.395, P=0.036). Conclusion The efficacy of HDDT and BQT in the treatment of HP infection is comparable, but the former has fewer adverse reactions.